This year (2013) proved to be a bit of a vintage, as once again the great and the good presented their Wonka bars of autism research; thus hinting at the direction of future autism research and what you can expect to read on this blog in the coming months. Oh, and something about poodles(?) (thanks Carol).

I've been hearing quite a bit of chatter about the keynote speech given by Prof. Christopher Gillberg which seemed to quite strongly hint that the autism research community should be paying rather more attention to the add-ons which seem to accompany a diagnosis of autism, rather than seeing autism as just existing stand-alone in a diagnostic vacuum.

Mention of the word ESSENCE - Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations* - has apparently been made in Prof. Gillberg's address denoting "the reality of children (and their parents) presenting in clinical settings with impairing child symptoms before age 3 (-5) years in the fields of (a) general development, (b) communication and language, (c) social inter-relatedness, (d) motor coordination, (e) attention, (f) activity, (g) behaviour, (h) mood, and/or (i) sleep". Before proceeding, I would perhaps suggest that Gillberg seems to have some interest in the use of acronyms in autism research and beyond as per the example of DAMP and MBD**.

Anyhow, a quick scan of the peer-reviewed research literature does indeed see a small but growing body of work discussing ESSENCE and its use in autism research circles. I note for example this paper by Prof. Brian Neville*** who highlights an essential part of the use of ESSENCE: that the presentation of behaviour in infants and young children is often complex, and the "problems are their multiplicity". Common sense perhaps?

Perhaps one of the best (so far) papers discussing the concept of ESSENCE in a real-world clinical setting is this one from Lotta Höglund Carlsson and colleagues**** (open-access) (which includes Gillberg as part of the authorship team). The paper is free for all to read so no great dissection required from me. That being said, I would highlight the fact that based on examination of just over 100 children diagnosed with an autism spectrum disorder (ASD), "a mean of 3.2 coexisting disorders or problems" were reported, including a third of children presenting with "severe hyperactivity/ADHD".

I was particularly interested in this autism-ADHD link given some other recent research on the overlap*****. That and the fact that additional reports have indicated even higher levels of overlap between autism and ADHD (see this post) calls into question whether the two labels may intersect even more than we perhaps have appreciated.

One of the potential implications of the co-occurrence of autism and ADHD is with regards to intervention and therapeutic options. Without trying to hijack the association with my dietary mumbo-jumbo, I would draw your attention to a previous post I published a while back on food and ADHD and some potential lesson for autism (see here). The suggestion there - and it was only a suggestion - was that some of the observations made when looking at the impact of a dietary intervention for autism actually working on some of the symptoms associated with ADHD might imply that targeting such comorbidity might eventually impact on more core autism presentation. A shocker I know that children being described as less impulsive and attending better might actually have better outcome.

I'm finishing shortly but before I do, I want to draw your attention to another ESSENCE mention in the paper by Stephanie Plenty and colleagues****** (open-access) who looked at the retrospective application of the concept in cases of adult ASD and ADHD. They similarly reported: "Although differences were observed between ADHD and ASD patients in the core diagnostic areas, these syndromes also shared a number of childhood difficulties".

ABOUT AUTISM SPECTRUM CONDITIONS

Autism or autism spectrum conditions describe several presentations characterised by core issues with social affect and stereotyped or repetitive actions. Diagnosis is made by observation and analysis of developmental history. These are heterogeneous conditions which can carry various co-morbidities and whilst described as life-long are affected by age and maturation. Autism means different things to different people. To some it means a need for life-long support. To others it is part of the varied tapestry of humanity. To all it means a need to foster a welcoming society with appropriate support and opportunities.